Strategies for Improving Care of Patients with Acute Kidney Injury Requiring Dialysis (AKI-D) in the Outpatient Hemodialysis Setting.

Patients with acute kidney injury often require dialysis (AKI-D) in the outpatient setting following hospitalization. Management of the patient with AKI-D should focus on preventing further insult to the damaged kidney and recovery of kidney function. Clinical attention should include continuity of care, education, infection control, medication management, and fluid management.

Medication Safety in Dialysis Care.

The outpatient dialysis setting presents unique challenges in the medication process. Dialysis staff conduct all steps in the medication process, including transcribing and verifying orders, preparing and administering medications, and monitoring for therapeutic and adverse effects. When addressing best medication practices, consideration should be given to education and resources provided to staff.

Comparative effectiveness of active oral vitamin D agents in patients on peritoneal dialysis.

Comparative Effectiveness Research (CER) has become positioned to inform health care decision-making with passage of the health care reform law, "Patient Protection and Affordability Care Act of 2010". As the name suggests, CER attempts to understand the relative efficacy between two therapies to allow clinicians, health care providers, and others to make rational decisions when evaluating therapeutic options. This is particularly relevant in the nephrology community as the dawn of bundled payments approaches.

Patient empowerment and motivational interviewing: engaging patients to self-manage their own care.

Patient empowerment is centered on the belief that patients should be in control of their own care and that behavioral changes and adherence to therapies cannot be achieved unless patients internalize the need for self-change. Data have consistently shown improved outcomes among patients on dialysis who are engaged, empowered and self-managing. Motivational interviewing provides a technique that can be applied by nephrology nurses to partner with patients and engage them in the management of their own care.

Mineral and bone disorders in patients on dialysis: physiology and clinical consequences.

Chronic kidney disease-mineral and bone disorder (CKD-MBD) arises from a series of independent, yet interrelated, disturbances in bone and mineral metabolism. The consequences of failing to control CKD-MBD include increased mortality, cardiovascular and soft-tissue calcification, renal osteodystrophy, and endocrine and bone marrow disturbances. An understanding of the physiology and clinical consequences of the disease illustrates the necessity of simultaneously controlling parathyroid hormone (PTH), calcium, phosphorus, and calcium-phosphorus product (Ca x P), as recommended by the Kidney Disease Outcomes Quality Initiative (KDOQ).

Chronic kidney disease and cardiovascular disease: a case presentation.

This is the third in a series of three articles examining cardiovascular disease (CVD) in the patient with chronic kidney disease (CKD). CVD is a leading cause of morbidity and mortality in patients with CKD, including those in the early stages. Early diagnosis of CKD and recognition of both traditional and nontraditional renal-related CVD risk factors are vital in improving outcomes for this population.

Chronic kidney disease and cardiovascular disease--using the ANNA Standards and Practice Guidelines to improve care. Part 1: the epidemiology of chronic kidney disease: the risk factors and complications that contribute to cardiovascular disease.

Recent National Kidney Foundation Kidney Disease Outcome Quality Initiative Guidelines for cardiovascular disease recommend that patients with chronic kidney disease be considered at highest risk for development of cardiovascular disease and that cardiac risk factor reduction begin with diagnosis of chronic kidney disease. Risk factors for cardiovascular disease in patients with chronic kidney disease include both traditional and nontraditional renal-related cardiac risk factors. The ANNA Nephrology Nursing Standards of Practice and Guidelines for Care can provide the foundation for planning care to patients with CKD and not only slow the progression of CKD but reduce exposure to cardiac risk factors.

The KDOQI clinical practice guidelines and clinical practice recommendations for treating anemia in patients with chronic kidney disease: implications for nurses.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative recently published revised clinical practice guidelines and recommendations for the treatment of anemia. This article provides an overview of the new guidelines and recommendations, with a focus on the hemoglobin treatment range, iron status, use of erythropoiesis-stimulating agents, and adjuvant therapies.

Vascular access blood flow monitoring reduces access morbidity and costs.

Background: Vascular access morbidity results in suboptimal patient outcomes and costs more than $8000 per patient-year at risk, representing approximately 15% of total Medicare expenditures for ESRD patients annually. In recent years, the rate of access thrombosis has improved following the advent of vascular access blood flow monitoring (VABFM) programs to identify and treat stenosis prior to thrombosis. To define further both the clinical and financial impact of such programs, we used the ultrasound dilution method to study the effects of VABFM on thrombosis-related morbid events and associated costs, compared with both dynamic venous pressure monitoring (DVPM) and no monitoring (NM) in arteriovenous fistulas (AVF) and grafts.

Physical assessment for patients receiving therapeutic plasma exchange.

As more nephrology programs include therapeutic plasma exchange (TPE), nephrology nurses must be prepared to treat the variety of indications for which TPE is prescribed. The purpose of this article is to assist nephrology nurses as they incorporate TPE into their scope of practice. The article addresses a total body systems approach to the physical assessment that is completed for all patients.

Technical considerations of therapeutic plasma exchange as a nephrology nursing procedure.

In the past, therapeutic plasma exchange (TPE) has had limited appreciation and lacked acceptance as a treatment modality. Jokingly, it has been referred to as a procedure looking for a disease because of seemingly broad historical applications to practice. In current clinical practice, TPE has earned its place as an aggressive therapeutic modality for treating a wide spectrum of diseases and/or syndromes.